For patients with abdominal wall endometriosis (AWE) — a condition that accounts for just a small fraction of all endometriosis patients — available treatment plans can be inherently limiting.
Surgical resection is a typical option offered to AWE patients, but this can lead to risks of incisional hernia in the lower abdomen. Additionally, because AWE is usually iatrogenic or diagnosed postoperatively, patients may resist the idea of another surgery. Another option, hormonal therapy, comes with low reported success rates and may only provide palliative relief.
Thankfully, focused ultrasound therapy is emerging as a minimally invasive treatment option for AWE that has the potential to make treating this form of endometriosis less daunting for both clinicians and their patients.
Focused Ultrasound: An Emerging Alternative
A growing number of patients and clinicians today are considering high-intensity focused ultrasound (HIFU) as a non-invasive alternative for treating AWE. Small-scale studies have demonstrated the technique's efficacy compared to surgery, and it has come across the radar of many practicing gynecologists worldwide. In China, for example, focused ultrasound has become a popular intervention for AWE.
HIFU involves the therapeutic use of ultrasound to direct energy to targeted nodules. As beams of energy intersect, ablation destroys the lesions without affecting healthy tissue, which prompts the lesions to shrink over time. Importantly, the technique is minimally invasive, potentially saving the costs associated with surgery, length-of-stay and surgical complications.
Notably, ultrasound plays a dual role as both a diagnostic and a therapeutic device. In addition to ablating targeted lesions, ultrasound assumes the role of thermal detector to accurately demarcate coagulation necrosis as it manages the outputting dose. Ultrasound is also used in followup appointments to measure lesion reduction.
Reported Successes of Ultrasound Therapy
Even though focused ultrasound therapy for endometriosis is not yet FDA-approved or covered by health insurance, the outcomes seen in small-scale Asian studies have been promising. For example, a retrospective analysis published in BJOG analyzed 32 patients who had undergone HIFU to treat AWE between 2010 to 2014 at a Chinese hospital. Focused ultrasound successfully ablated all lesions in the study; during the six-month follow-up, average lesion size and pain scores went down. There were no severe adverse events.
A retrospective study published in The Journal of Minimally Invasive Gynecology compared the outcomes of 30 patients with AWE. 13 underwent ultrasound ablation, while 17 had surgical resection. The focused ultrasound group experienced shorter post-treatment length-of-stay as well as a lower incidence of fever and urinary complications. The treatment resolved pain in both groups, although one surgical patient did have symptoms come back within a year after surgery.
One case study published in Gynecological Endocrinology, focused on a 37-year-old Korean patient with a 0.9 cm nodule, showed that HIFU did effectively treat AWE. At a three-month follow-up, clinicians noted that the nodule had shrunk and the patient's pain was gone. The patient experienced no burns or blisters from the procedure.
Though more research is needed before HIFU can be applied stateside, focused ultrasound is nonetheless a promising mode of treatment. Given the growing popularity of minimally invasive measures coupled with healthcare pressures to cut costs, it is expected that the procedure will garner more attention in the years ahead.
